hospice in LTC?

tex · Jun 1, 2002

Micro, I respect your thought r/t Hospice, but I am not sure where your LTC is located but what you experience and have seen with your local hospice is not at all what I have provided in my years w/hospice in two different states I might add. I am now a coordinator at a LTC and I do pitch in to help with the nurses/cna's in regards to understanding hospice. First of all, the hospice nurse not only is a support system for the patient & their families, but the most critical part is asking you the nurse what can I do to help you out and your staff. The hospice nurse if he or she is doing her job right, should be a specialist in pain management and know how to keep the patient comfortable w/o using one needle. The hospice nurse should keep tabs on the pain, constipation, n/v and nutritional and overall well being of that special patient. You should be instructed to call this hospice nurse (and if the hospice nurse isn't available, there is ALWAYS a nurse on call). I would call the doctor and discussed pain management and updated the doctor on the progress of the patient, without stepping on anyones toes. And did obtain orders w/o difficulty for any LTC.........Every nurse I worked with, new to page me or call my office. They would give me an update, and I always offered suggestions, and if that nurse objected (which they never did) I would obtain any order that LTC nurse needed and f/u to see if it was effective. I just didn't go in a LTC 1x aweek, if the patient was getting close, my visits increased to meet the demands of keeping not only the patient and their families but ESPICALLY the LTC nurses and staff. I arranged for our volunteers to go in a sit with the patient so the family could get rest. And most importantly to give the LTC staff a break. Our social worker made multiple visits, and he or she always wanted to know what the patient/family and again most importantly what the STAFF needed. Hey your are right on one account. I couldn't administer the medications, but I cleaned up plenty of soiled patients and gave bed baths my self, including the rest of the hospice staff. I feel bad for the hospice patients you have in your facility, they truley are missing out on what is the most important thing they have left, to die with dignity, a sense of acceptance/well being and in no Pain...........Tex

Fran-RN · Jun 3, 2002

As I said previously, there are differences in hospice providers, just as there are in other areas. The good ones deliver a much needed service to the families, residents and staff. I have found that if there are good communication and responsibility guidelines provided at the beginning then things go much more smoothly for everyone concerned.

StormyCD · Jun 6, 2002

My experiences with hospice in my LTC facility have not been good. I've been told that they can come and take a blood pressure, and I quote "I can tell you she's dying, DUH!"..Also when i had a resident that had a fever of 105.3 I called hospice to imform them. It took them 35 minutes to call me back..and that was after I had called a second time! When they did call, she just said, "Well, I guess it's just her time to go". This resident was actually coherent, and stated she felt like SH__!. I told them her urine was dark and cloudy and it was probably a UTI. In all, it took 1 hour and 15 minutes for them to arrive. I had given Tylenol Supp. and ice packs to the body, by the the time they got there her fever was down to 101.2. I was on the verge of sending her to the E.R. for an evaluation when they finally showed up. I've also been told on SEVERAL occassions that the R.N. on duty (me) could pronounce expiration and then call Hospice! Because they didn't want to get up at 300am and come to see the resident or provide emotional support for the resident or the family. But! If I tried to write an order for my resident they would jump down my throat for not consulting them first! I'm sorry, I realize there are a lot of good nurses out there in hospice, I have yet to meet one in my area. I feel like Medicare is paying twice for the care given to the resident. And I don't like being told I can't do something for my resident. We are with that resident for 8 to 16 hours a day, 7 days a week, 365 days a year. We feed them, comb their hair, etc. etc. We celebrate their birthdays and anniversaries, Yet when they leave this world I'll see in the paper where the family has requested donations to hospice instead of flowers for the funeral. It just burns me up......thanks for letting me vent.

tex · Jun 7, 2002

Stormy, I strongly suggest that you notify the director of the Hospice that your facility has a contract with. And report exactly how you fell and documented info. First of all, when a patient is in a LTC hospice setting, you should have standing orders from hospice that the MD has approved of, so you don't have to guess what or what not to do. The standing orders I developed for two Hospices, were a life savior for the Nurses such as you. Also unless the patient was symptomatic "fever, retention etc" antibotics are not given. When the UTI is colonized why give meds. In this patience case, The hospice nurse should be turned in. My standing practice to all the facilities is that when you page us, wait 15 minutes, if no reply, page again, if that doesn't work then you call the answering service and DEMAND to speak to the Supervisor. Because I covered at times 4 hospitals when I took call on the week ends or for that matter regular work days, I would call back, speak to the nurse and tell them exactly where I was driving from, and always stated can you wait 20 min or 40 min? Explaining where you are driving from is critical to YOU> This puts the nurse in charge, at the time, meaning YOU some time frame, and 1/2 the time, calling YOU via cell phone alot of interventions and other treatments can be taken care of. This isn't any different than in regular nursing. Now about the payment. Please refer to how the payment system is done. NO ONE gets paid twice. Hospice has a contract with your facility, that is an exact amount that the LTC will get paid. DOUBLE DIPPING is against the law in any state! Now thank you for allowing me to vent...................TEX

aimeee, BSN, RN · Jun 7, 2002

Definitely give the hospice feedback. Let them know you find their service poor. It saddens me when I hear of performance like this. You, the patients, and the families, deserve better.

skl0923 · Jul 14, 2002

I am a charge nurse in LTC, been there since I graduated.

I have about 5 Hospice patients at this time, and have said goodbye to 5 in the past year. I have asked for Hospice consult from Doctors 4 times in the past month.

We have a wonderful hospice team to work with. Latest patient consult resulted in denial for Hospice care, but accepted for Hospice Pain Control consultation and management. Thank god.

My patient is chronic pain from Fibromyalgia, neuralgia, Back pain

and has allergies to quite a few pain medications. She is now getting better relief, but we are working thru the dosing right now.

Hospice provides an invaluable service to their residents and our staff. They will come out whenever we ask them to. Even on holiday weekend. We have 3 residents that have hospice caregiver come in once a week. They provide a few more hours of care and specialties that our staff does not have time for, like massage, spends an extra hour with one on one care for ADL's.

Rn case manager visits at least once a week, mostly twice a week. We can call her anytime for advice. She faxes or calls our doctor if needed, mostly we do, unless she wants to introduce new protocol. They attend care plan meetings for terminal patients.

Our families get the added support from hospice that with 30 residents, I do not have time to provide on a day to day basis.

So I say thank god for the hospice program, and thank god it is not just for the dying patient. We in long term care need all the help and advice we can get. Regs and rules are taking so much time away from direct patient care.

tex · Jul 14, 2002

It is so good to read something positive about Hospice in LTC, SKL0923. Unfortunately, a lot of LTC nurses don't have the support you have, you are experiencing the true benifit from your Hospice Team................TEX

jschut, BSN, RN · Jul 15, 2002

We have a lady in our care who receives hospice nursing. I have mixed feelings about it because sometimes, the nurse is there to provide support to this lady, but at other times, she does some of the dingiest things! For instance, the pt fell because the hospice nurse neglected to put her side railings up one day after she left...

(May not be the complete and total reason, but still, why weren't the rails put up?)

I think Hospice Nursing is a wonderful thing though for homebound folks.....

ktwlpn, LPN · Jul 18, 2002

Originally posted by tinkertoys
I have just been told that LTC centers are being strongly advised to offer hospice for their terminal patients. This confuses me. First, I feel that we do a good job of supporting our end-stage patients and their families. We have MD's that work with us to provide adequate pain control. we try to keep in good communication with families, to keep them informed, and we do our best to see that our patients don't die alone. I understand that hospice has a more organized support structure, but I truly don't understand what purpose would be served by involving hospice with our patient's care. It seems to me that that would take the pt's care out of our hands, and make us little more that a housing provider. I have also heard of hospice patients that were told that if they signed with the hospice, they were not to go to the hospital for any reason. Please understand-- I have the utmost respect for hospice. I believe it provides a much-needed service to our terminally ill and their families. I just don't see where it applies in this case.

>>>>>>>>>We are currently undergoing survey and hospice does seem to be a big concern.All of the surveyors are asking all staff why we don't have it and how do we deal with the residents and give support to the familiies.Our facility does not have it -the DON and the head of social services are very much against it.I hear that they feel "it is a slap in the face for someone to come in and tell US how to do our jobs"I am hoping that we do bring hospice in- a few of our staff docs are not into pain control at all and some nurses are better then others at dealing with end of life issues.I think it would (of course) be great for the residents and also a great public relations tool-any nurses coming in from an outside agency will be impressed with our staffing and the care our residents receive. A few of our staff docs are very resistant to giving up ANY control-everything has to be their idea-you have to lead them to a new clue and let them discover it to get them to do what you want....(anyone know what I mean?) They have been opposed vehemently to standing orders (which we would love) Should be interesting.....

nakitamoon · Jul 19, 2002

As I live in Florida,,,,, been working in geratrics,,,my career as a nurse,,,,,, first as charge in 20 bed,,,skilled facility attatched to an assisted living,,,,,,,, 5 years ago I became the D.O.N. of the assisted living department,,,,,,

Both on the skilled unit,,,,,and in assisted living we use Hospice,,,, We have a great relationship with them and they provide extra,,,, support,,,, care,,,, tx,,,, for our residents,,,, they otherwise would not get,,,,,, Another voice for family members to talk with,,,,, a chaplin,,,,, find thier services wonderful,,,,, Wouldn't want to do this without them,,,

Have helped me keep residents in thier "home" which they come to feel the assisted living is,,,,,,, and not into a skilled unit,,,,,, to have the best quaility of life,,,,,, until they pass on,,,,,,,

Speaking for the skilled unit,,,,,, the charge nurses,,,, cna's,,,,, and D.O.N. give the best care they can,,,, it is enchanced by hospice,,,, as with me,,,, thier services,,, are greatly needed and apprieciated,,,,,,,, ~~Moon~~

shygirl · Jul 21, 2002

We also have Hospice in our LTC facility. I think it's great. We are so busy with many other patients and the Hospice person has the time to be with them 24/7.

RNConnieF · Jul 21, 2002

We bring in hospice too. The hospice nurse has different protocols re: pain control and treatments than the MD's usually write. Once hospice has been called they write the orders. It has been my experience that death is far more comfortable for the pt. and family with hospice involved. I make it a point to reccomend hospice to famlies.